The pneumonia caused by the coronavirus disease-2019(COVID-19)outbreak in Wuhan,China constitutes a public health emergency of international concern.The gastrointestinal symptoms of vomiting,diarrhea and abdominal pai...The pneumonia caused by the coronavirus disease-2019(COVID-19)outbreak in Wuhan,China constitutes a public health emergency of international concern.The gastrointestinal symptoms of vomiting,diarrhea and abdominal pain and the detection of COVID-19 nucleic acid from fecal specimens in a small number of patients suggest the possibility of transmission via the gastrointestinal tract.People of all ages are vulnerable to this virus,including children.Digestive endoscopy is an invasive procedure during which children cannot wear masks;therefore,they have higher risks of exposure to COVID-19,and the digestive endoscopy center is a relatively high-risk area for COVID-19 infection.Based on these factors and in combination with related policies and regulations,a prevention and control program for the COVID-19 pneumonia in a children's digestive endoscopy center was established to prevent the COVID-19 nosocomial infection.展开更多
BACKGROUND As lifestyles continue to change worldwide,the incidence of digestive tract carcinoma has gradually increased.Digestive endoscopy is an important tool that can assist in the diagnosis,treatment,and surgical...BACKGROUND As lifestyles continue to change worldwide,the incidence of digestive tract carcinoma has gradually increased.Digestive endoscopy is an important tool that can assist in the diagnosis,treatment,and surgical intervention for this disease.However,the examination process is affected by many factors,and patient cooperation is often poor,which can increase the risk of complications.AIM To explore the effects of integrated management and cognitive intervention on cooperation and complications in patients undergoing endoscopy for early gastrointestinal neoplasms.METHODS A total of 354 patients with early stage gastrointestinal cancer who underwent digestive endoscopy procedures between January and December 2023 at our hospital were divided into observation and control groups(177 patients in each group)in a randomized controlled blind trial.The control group received routine interventions,while the observation group received comprehensive integrated management combined with cognitive interventions.We compared the changes in adverse mood,discomfort,examination time,cooperation with the examination,and complications before and after the intervention between the two groups.RESULTS The self-rated anxiety and depression scale scores were lower in the observation group than in the control group(P<0.05).The visual analog scale scores for discomfort during intubation and examination were also lower in the observation group than in the control group(P<0.05).Furthermore,the examination time was shorter in the observation group than in the control group(P<0.05),and the degree of cooperation(94.35%)was higher in the observation group than in the control group(84.75%;P<0.05).Lastly,the incidence rates of gastrointestinal adverse reactions(10.17%vs 20.34%),choking agitation(14.69%vs 24.86%),abdominal pain(8.47%vs 18.08%),and muscle tension(5.08%vs 14.12%)were all lower in the observation group than in the control group(P<0.05).CONCLUSION Integrated management and cognitive intervention in early gastrointestinal neoplasm endoscopy alleviate mood,reduce discomfort,shorten examinations,improve cooperation,and reduce complications.展开更多
BACKGROUND Tens of millions of gastrointestinal endoscopic procedures are performed every year in China,but the quality varies significantly and related factors are complex.Individual endoscopist-and endoscopy divisio...BACKGROUND Tens of millions of gastrointestinal endoscopic procedures are performed every year in China,but the quality varies significantly and related factors are complex.Individual endoscopist-and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy.AIM To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in China's Mainland.METHODS Selected data on endoscopy experience,equipment,facility,qualification of endoscopists,and other relevant variables were collected from the National Database of Digestive Endoscopy of China.The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance.Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications.RESULTS In 2012,gastroscopy/colonoscopy-related complications in China's Mainland included bleeding in 4,359 cases(0.02%)and perforation in 914(0.003%).Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases(0.3%),bleeding in 2,151(1.10%),perforation in 257(0.13%)and biliary infection in 4,125(2.11%).Moreover,1,313(5.0%)endoscopists encountered with medical malpractice,and 5,243(20.0%)encountered with the disturbance from patients.The length of endoscopy experience,weekly working hours,weekly night shifts,annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance.However,the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications.CONCLUSION The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance.More comprehensive data are needed to establish quality-predictive models for endoscopic complications.展开更多
Background:There is scant evidence regarding the effects of exercise type and duration on quality of life(QoL)in digestive system cancer(DSC)survivors.We aim to investigate the optimal type and duration of exercise to...Background:There is scant evidence regarding the effects of exercise type and duration on quality of life(QoL)in digestive system cancer(DSC)survivors.We aim to investigate the optimal type and duration of exercise to improve QoL for DSC survivors through a systematic review and network meta-analysis.Methods:A systematic literature search of PubMed,Embase,and Web of Science was performed.Eligibility for study inclusion was limited to studies that were randomized controlled trials involving all kinds of exercise in adult patients with DSCs,and the comparator was in standard care or other types of exercise.The primary outcome was QoL,including general health,physical health,mental health,and role function.Secondary outcomes included cancer-related symptoms such as fatigue,insomnia,depression,anxiety,and duration of hospital stay.The network meta-analyses were performed using a random-effect model.Results:The analysis included 32 eligible articles and a total of 2558 participants.Our primary outcome indicated that short-term aerobic exercise significantly enhanced general health(standardized mean difference(SMD)=0.66,95%credible intervals(Crls):0.05 to 1.30),and also contributed to a better mental health(SMD=0.38,95%CrI:-0.05 to 0.81)and role function(SMD=0.48,95%CrI:-0.27 to 1.20).Although without significant changes,short-term resistance exercise tended to increase the physical health of patients with DSCs(SM=0.69,95%CrI:-0.07 to 1.50)and effective in alleviating fatigue(SMD=-0.77,95%CrI:-1.50 to 0.01).Short-term aerobic exercise was related to a lower score of insomnia(SMD=-1.20,95%CrI:-2.40 to 0.06),depression(SMD=-0.51,95%CrI:-1.50 to 0.45),and anxiety(SMD=-0.45,95%CrI:-1.30 to 0.34).All types of exercise related to a trend of declined hospital stays(-0.87 to-5.00 day).Long-term resistance exercise,however,was negatively associated with general health(SMD=-0.33,95%CrI:-1.70 to 1.00),physical health(SMD=-0.18,95%CrI:-1.30to 0.90),and role function(SMD=-1.20,95%CrI:-2.50 to 0.11).Conclusion:This study suggests that short-term aerobic exercise,with or without resistance exercise programs,enhances QoL(especially for general health)as well as relieves cancer-related symptoms for DSC survivors,while long-term resistance exercise may have negative effects,and thus should be adopted cautiously.These results provide important evidence for the management of DSCs.展开更多
BACKGROUND Endoscopic placement of a self-expandable metal stent(SEMS)is a minimally invasive treatment for use in malignant and benign colonic obstruction.However,their widespread use is still limited with a nationwi...BACKGROUND Endoscopic placement of a self-expandable metal stent(SEMS)is a minimally invasive treatment for use in malignant and benign colonic obstruction.However,their widespread use is still limited with a nationwide analysis showing only 5.4%of patients with colon obstruction undergoing stent placement.This underutilization could be due to perceived increase risk of complications with stent placement.AIM To review long-and short-term clinical success of SEMS use for colonic obstruction at our center.METHODS We retrospectively reviewed all the patients who underwent colonic SEMS placement over aeighteen year period (August 2004 through August 2022) at our academic center. Demographicsincluding age, gender, indication (malignant and benign), technical success, clinical success,complications (perforation, stent migration), mortality, and outcomes were recorded.RESULTSSixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were formalignant indications, 8 were for benign conditions. The benign strictures included diverticulardisease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemicstricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primaryor recurrent colon cancer;12 were from extrinsic compression. Fifty-four strictures occurred on theleft side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55)procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication ratewas significantly higher for benign group: Four complications were observed in the malignantgroup (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stentmigration) (P = 0.02). When stratifying complications of perforation and stent migration there wasno significant difference between the two groups (P = 0.14, NS).CONCLUSIONColon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has ahigh procedural and clinical success rate. Benign indications for SEMS placement appear to havesimilar success to malignant. While there appears to be a higher overall complication rate inbenign cases, our study is limited by sample size. When evaluating for perforation alone theredoes not appear to be any significant difference between the two groups. SEMS placement may bea practical option for indications other that malignant obstruction. Interventional endoscopistsshould be aware and discuss the risk for complications in setting of benign conditions. Indicationsin these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.展开更多
Objective: to explore the clinical effect of upper digestive system hemorrhage under gastrointestinal endoscopy. Methods: the 100 patients with massive upper digestive system bleeding hospitalized from February 2018 t...Objective: to explore the clinical effect of upper digestive system hemorrhage under gastrointestinal endoscopy. Methods: the 100 patients with massive upper digestive system bleeding hospitalized from February 2018 to September 2020 were divided into two groups according to the treatment plan, 50 patients underwent gastroscopy, 50 patients received traditional hemostasis, and the results were compared with the time of hemostasis treatment. Results: comparing the efficacy of the two methods, the hemostasis visualization efficiency of 50 patients was 96% compared to 78%;the bleeding duration (0.87 + 0.35) d, admission days (3.4) d;1.89 + 1.12 d in treatment group, 5.8-2.1 d;significant differences between both groups (P 0.05);control patients (P 0.05). Conclusion: in the clinical treatment of patients with upper gastrointestinal bleeding, it can achieve an ideal hemostasis effect in a relatively short time, and has a higher safety value. It is suggested to be widely used in clinical practice.展开更多
BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the fact...BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors.METHODS The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected.According to radical resection criteria,the patients were further divided into curative resection group(n=143)and NCR group(n=30).Clinical information was collected,including surgical method,tumor diameter,tumor site,ulcer formation,depth of invasion,pathological type,and lymph node metastasis.Logistic regression analysis was used to explore the factors affecting non-curable resection.RESULTS Multivariate logistic regression analysis showed that ulcer formation[odds ratio(OR)=3.53;95%confidence interval(CI):1.55-8.01,P=0.003],pathological type(OR=3.73;95%CI:1.60-8.74,P=0.002),tumor diameter(OR=3.15;95%CI:1.40-7.05,P=0.005),tumor location(OR=3.50;95%CI:1.16-10.58,P=0.027),lymph node metastasis(OR=4.40;95%CI:1.83-10.57,P=0.001),and depth of penetration(OR=3.75;95%CI:1.60-8.74,P=0.002)were all risk factors for NCR in EGC patients.Predictive analysis showed varying area under the curve values for factors such as tumor diameter(0.636),tumor location(0.608),ulcer formation(0.652),infiltration depth(0.658),pathological type(0.656),and lymph node metastasis(0.674).CONCLUSION The results suggest that factors such as tumor diameter,tumor location,ulcer formation,depth of invasion,pathological type,and lymph node metastasis increase the risk of NCR in EGC patients.展开更多
BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particu...BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.展开更多
BACKGROUND Acute abdominal pain is one of the most common gastrointestinal symptoms.The etiology of acute abdomen can be challenging for gastroenterologists to establish.Cecal foreign body is a rare cause of cecal per...BACKGROUND Acute abdominal pain is one of the most common gastrointestinal symptoms.The etiology of acute abdomen can be challenging for gastroenterologists to establish.Cecal foreign body is a rare cause of cecal perforation.CASE SUMMARY We report a 35-year-old male from China who initially exhibited symptoms suggestive of acute appendicitis.However,during a minimally invasive colonoscopy procedure,the authors found that a wooden toothpick caused the perforation.The patient presented to our emergency department with a 2 days history of right lower abdominal pain and low grade fever.The patient was in good health and had eaten fish 2 days earlier.Physical examination revealed mild pain with positive rebound tenderness in the right lower abdomen.However,computed tomography of the abdomen confirmed a strip of high-density shadows protruding beyond the intestinal cavity outline,with a small amount of peritoneal seepage in the ileocecal area.Combined with the medical history,the possibility of foreign body perforation by a fishbone and peripheral peritonitis were considered.However,the high-density shadow was identified as a wooden toothpick,which was removed via a minimally invasive procedure using a foreign body forceps under colonoscopy.The patient's condition improved significantly within 5 days after treatment.CONCLUSION We emphasize the importance of a detailed patient history,accurate diagnosis and proper treatment in patients with acute abdomen.展开更多
BACKGROUND The clinical and pathological characteristics of primary gastric small cell carcinoma(GSCC)resemble those of small cell lung cancer,which is less sensitive to chemotherapy and has a poor prognosis.Currently...BACKGROUND The clinical and pathological characteristics of primary gastric small cell carcinoma(GSCC)resemble those of small cell lung cancer,which is less sensitive to chemotherapy and has a poor prognosis.Currently,platinum-etoposide chemotherapy is a primary chemotherapy regimen for small cell carcinoma,but it is still imperfect.Programmed cell death ligand 1(PD-L1)inhibitors are recommended for the treatment of small cell lung cancer.However,to determine whether PD-L1 inhibitors are optimal for metastatic GSCC requires more clinical data.CASE SUMMARY A 67-year-old male experienced upper abdominal pain without any obvious cause for 1 week.Gastroscopy examination revealed a mass in the gastric body.Pathological examination of the biopsy specimen combined with immunohistochemistry showed a high-grade neuroendocrine carcinoma(small cell carcinoma).Genetic tests showed TP53,CREBBP,RB1,ABCB1,DNMT3A,and HGF gene mutations.Computed tomography(neck+chest+abdomen)showed multiple enlarged lymph nodes,occupying space in the greater curvature of the stomach and intrahepatic metastases.A regimen consisting of cisplatin and etoposide combined with durvalumab was administered every three weeks as palliative chemotherapy,for seven cycles.Durvalumab was then maintained every three weeks.However,the tumor recurred two months after the completion of chemotherapy.A regimen consisting of carboplatin and irinotecan combined with durvalumab was then given every three weeks.The tumor in the gastric body and liver shrank significantly,and the patient did not report any specific discomfort.CONCLUSION GSCC is a highly malignant tumor with a poor prognosis.Whether immune-related drugs are optimal for metastatic GSCC requires further exploration.展开更多
BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisu...BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisum with obstruction of the minor papilla,or an abnormal patulous orifice of the minor papilla during endoscopic retrograde cholangiopancreatography(ERCP).However,the relatively low pa-tency and small opening of the minor papillae pose technical challenges.AIM To evaluate the technical success,clinical success,stone clearance,and safety pro-file of EMPI for diagnosis and treatment of symptomatic pancreatic diseases.METHODS Patients diagnosed with symptomatic pancreatic diseases and EMPI between February 1996 and February 2023 were included.The primary outcomes were the initial technical success,defined as successful deep cannulation via the minor papilla(DCMP;access of the guidewire to the upstream pancreatic duct via the minor papilla)alone,overall technical success,defined as successful DCMP alone and successful DCMP with additional needle-knife precut minor papillotomy(NKPMP),and immediate clinical success,defined as>50%improvement in abdominal pain after therapeutic EMPI.Secondary outcomes included long-term clinical success at 1,3,and 7 years,pancreatic stone clearance,and procedure-related early and late adverse events(AEs).RESULTS Overall,43 patients,32 with obstructive chronic pancreatitis,8 with pancreatic divisum,and 3 with intraductal papillary mucinous neoplasm were included.The initial and overall technical success rates were 74.4%(32/43)and 88.4%(38/43),respectively.The immediate clinical success rate was 79.1%(34/43),and the long-term clinical success rates at 1,3,and 7 years were 74.7%,55.3%,and 41.5%,respectively,among the 22 patients with a follow-up period of 57.5(7-266)months.Complete and partial success of pancreatic stone clearance was achieved in 53.9%(7/13)and 15.4%(2/13),respectively.Early AEs included post-ERCP pancreatitis(PEP,n=5)and self-limiting bleeding(n=1);surgery therapy was required for 1 case with severe PEP and conservative management for the other 4 with mild PEP.Late AEs included minor papilla stricture(n=1)after endoscopic minor papillotomy and pancreatic duct stricture(n=1)after double pancreatic stent placement;no specific treatment was implemented for these events.CONCLUSION EMPI is feasible,effective,and safe for symptomatic pancreatic diseases,in terms of the technical and clinical success,stone clearance,and incidence and severity of AEs.NKPMP appears to enhance technical success.However,potential risks of developing PEP and late AEs should be kept in mind.展开更多
Early screening is crucial for the prevention of intestinal-type gastric cancer.The current study aimed to ascertain the molecular evolution of intestinal-type gastric cancer based on the Correa cascade for precise ga...Early screening is crucial for the prevention of intestinal-type gastric cancer.The current study aimed to ascertain the molecular evolution of intestinal-type gastric cancer based on the Correa cascade for precise gastric cancer screening.We collected sequential lesions of the Correa cascade in the formalin-fixed and paraffin-embedded endoscopic submucosal dissection(ESD)-resected specimens from 14 Chinese patients by microdissection,and subsequently determined the profiles of somatic aberrations during gastric carcinogenesis using whole-exome sequencing,identifying multiple variants at different Correa stages.The results showed that TP53,PCLO,and PRKDC were the most frequently mutated genes in early gastric cancer(EGC).We found a high frequency of TP53 alterations in low-grade intraepithelial neoplasia(LGIN),which further increased in high-grade intraepithelial neoplasia(HGIN)and EGC.Intestinal metaplasia(IM)showed no significant correlation with EGC in terms of mutational spectra,whereas both LGIN and HGIN showed higher genomic similarities to EGC,compared with IM.Based on Jaccard similarity coefficients,we constructed three evolutionary models,with most patients showing linear progression from LGIN to HGIN,ultimately resulting in EGC.The extracellular matrix-receptor interaction pathway was revealed to be involved in the linear evolution.Additionally,the retrospective validation study of 39 patients diagnosed with LGIN indicated that PRKDC mutations,in addition to TP53 mutations,may drive LGIN progression to HGIN or EGC.In conclusion,the current study unveils the genomic evolution across the Correa cascade of intestinal-type gastric cancer,elucidates the underlying molecular mechanisms of gastric carcinogenesis,and provides evidence for potential personalized gastric cancer surveillance.展开更多
Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce...Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.展开更多
AIM: To investigate the effect of prophylaxis withantibiotics on clinical adverse events in patients who underwent endoscopic submucosal dissection(ESD) or endoscopic mucosal resection(EMR) for colorectal lesions.METH...AIM: To investigate the effect of prophylaxis withantibiotics on clinical adverse events in patients who underwent endoscopic submucosal dissection(ESD) or endoscopic mucosal resection(EMR) for colorectal lesions.METHODS: From June 2011 to December 2013, a total of 428 patients were enrolled into the study, of which 214 patients admitted to hospital underwent EMR or ESD procedures. These patients were randomized to an antibiotic group, in which patients were given cefuroxime 1.5 g iv half an hour before and 6 h after surgery respectively, and a control group, in which patients were not given any antibiotic. A further 214 outpatients with small polyps treated by polypectomy were compared with controls that were matched by age and gender, and operations were performed as outpatient surgery. Recorded patient parameters were demographics, characteristics of lesions and treatment modality, and the size of the wound area. The primary outcome measures were clinical adverse events, including abdominal pain, diarrhea, hemotachezia, and fever. Secondary outcome measures were white blood cell count, C-reactive protein and blood culture. Additionlly, the relationship between the size of the wound area and clinical adverse events was analyzed. RESULTS: A total of 409 patients were enrolled in this study, with 107 patients in the control group, 107 patients in the antibiotic group, and another 195 cases in the follow-up outpatient group. The patients' demographic characteristics, including age, gender, characteristics of lesions, treatment modality, and the size of the wound area were similar between the 2 groups. The rates of adverse events in the antibiotic group were significantly lower than in the control group: abdominal pain(2.8% vs 14.9%, P < 0.01), diarrhea(2.0% vs 9.3%, P < 0.05), and fever(0.9% vs 8.4%, P < 0.05) respectively. The levels of inflammatory markers also decreased significantly in the antibiotic group compared with the control group: leukocytosis(2.0% vs 11.2%, P < 0.01), and C-reactiveprotein(2.0% vs 10.7%, P < 0.05). Additionally, clinica adverse events were related to the size of the surgica wound area. When the surgical wound area was larger than 10 mm × 10 mm, there were more clinica adverse events.CONCLUSION: Clinical adverse events are not uncommon after EMR or ESD procedures. Prophylactic antibiotics can reduce the incidence of clinical adverse events. This should be further explored.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD) is a common surgical strategy for the treatment of early gastrointestinal tumors and precancerous lesions.PDCA nursing can effectively prevent potential risks in the nu...BACKGROUND Endoscopic submucosal dissection(ESD) is a common surgical strategy for the treatment of early gastrointestinal tumors and precancerous lesions.PDCA nursing can effectively prevent potential risks in the nursing process,protect patient privacy,and improve patient satisfaction,nursing integrity,and service quality.AIM To explore the effects of PDCA nursing model on the quality management of gastrointestinal ESD,the 36-item Shot-Form Health Survey(SF-36) score,and negative emotions.METHODS A total of 178 patients who underwent ESD between January 2020 and January 2021 were divided into two groups.The usual care mode was the control group,with 80 cases from January to July 2020;from July 2020 to January 2021,98 patients were enrolled in the PDCA care mode as the research group.The length of hospital stay and the costs of the two groups were statistically analyzed.The visual analog scale(VAS),SF-36 score,Zung self-rating scale for anxiety and depression,and postoperative complications were also assessed.RESULTS The length of hospitalization and cost in the research group were lower than in the control group(P < 0.05),and the VAS scores were lower than those before care(P < 0.05).Moreover,the VAS score of the research group was lower than that of the control group(P < 0.05).The SF-36 scores for physical function,role status,social function,pain,mental health,and physical strength were higher in the research group than in the control group(P < 0.05).Depression and anxiety scores of the research group were lower than those of the control group(P < 0.05).The postoperative complication rate in the research group(6.12%) was lower than in the control group(32.50%)(P < 0.05).CONCLUSION PDCA nursing can improve the quality of management of ESD surgery,shorten the length of hospital stay and cost,reduce the VAS and Zung scale scores to alleviate adverse emotions,improve the SF-36 score,and reduce postoperative complications.展开更多
Background:Worldwide,the volume and availability of digestive endoscopy have undergone dramatic development in recent years,with increasing attention on quality assurance.We investigated the utilization and quality of...Background:Worldwide,the volume and availability of digestive endoscopy have undergone dramatic development in recent years,with increasing attention on quality assurance.We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions.Methods:We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually.The questionnaires included the personnel,annual volume,and quality indicators of endoscopy.An endoscopy quality index(EQI)was developed based on recorded quality indicators using principal component analysis to determine the relative weight.Results:From 2015 to 2019,806,1412,2644,2468,and 2541 hospitals were respectively enrolled in this study.The average annual volume of endoscopy increased from 12,445 to 16,206(1.30-fold)and from 2938 to 4255(1.45-fold)in tertiary and secondary hospitals,respectively.The most obvious growth was observed in diagnostic colonoscopy(1.44-fold for all hospitals after standardization).The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3%(55,210/448,861)to 17.7%(85,429/482,647)and from 11.4%(69,411/608,866)to 16.9%(107,192/634,235),respectively.The adenoma detection rate of diagnostic colonoscopy increased from 14.9%(2,118,123/14,215,592)to 19.3%(3,943,203/20,431,104).The EQI model included 12 quality indicators,incorporating 64.9%(7.792/12)of the total variance into one comprehensive index.According to the EQI measurements,the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals.Conclusions:Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality.The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.展开更多
BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of...BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.展开更多
BACKGROUND： One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over- growth of bacteria. This study aimed to evaluate the feasibility of a novel silver=nanoparticle...BACKGROUND： One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over- growth of bacteria. This study aimed to evaluate the feasibility of a novel silver=nanoparticle-coated polyurethane （Ag/PU） stent in bacterial cholangitis model in swine. METHODS： Ag/PU was designed by coating silver nanopar- tides on polyurethane （PU） stent. Twenty-four healthy pigs with bacterial cholangitis using Ag/PU and PU stents were ran- domly divided into an Ag/PU stent group （n=12） and a PU stem group （n=12）, respectively. The stents were inserted by standard endoscopic retrograde cholangiopancreatography. Laboratory assay was performed for white blood cell （WBC） count, alanine aminotransferase （ALT）, interleukin-1 [l （IL- 1 p）, tumor necrosis factor-a （TNF-~） at baseline time, 8 hours, 1, 2, 3, and 7 days after stent placements. The segment of bile duct containing the stent was examined histologically ex vivo. Implanted bili- ary stents were examined by a scan electron microscope. The amount of silver release was also measured in vitro. RESULTS： The number of inflammatory cells and level of ALT, IL-1β and TNF-α were significantly lower in the Ag/PU stent group than in the PU stent group. Hyperplasia of the mucosa was more severe in the PU stent group than in the Ag/PU stent group. In contrast to the biofilm of bacteria on the PU stent, fewer bacteria adhered to the Ag/PU stent. CONCLUSIONS： PU biliary stents modified with silver nanoparticles are able to alleviate the inflammation of pigs with bacterial cholangitis. Silver-nanoparticle-coated stents are resistant to bacterial adhesion.展开更多
Background： Endoscopic papillary balloon dilation （EPBD） for common bile duct （CBD） stones removal in Billroth II gastrectomy patients is feasible. However, the long-term outcomes of this technique are notclear. ...Background： Endoscopic papillary balloon dilation （EPBD） for common bile duct （CBD） stones removal in Billroth II gastrectomy patients is feasible. However, the long-term outcomes of this technique are notclear. The aim of this study was to evaluate the procedural and long-term outcomes of EPBD for removal of CBD stones in Billroth II gastrectomy patients.展开更多
BACKGROUND Choledocholithiasis is a severe disorder that affects a significant portion of the world’s population.Treatment using endoscopic sphincterotomy(EST)has become widespread;however,recurrence post-EST is rela...BACKGROUND Choledocholithiasis is a severe disorder that affects a significant portion of the world’s population.Treatment using endoscopic sphincterotomy(EST)has become widespread;however,recurrence post-EST is relatively common.The bile microbiome has a profound influence on the recurrence of choledocholithiasis in patients after EST;however,the key pathogens and their functions in the biliary tract remain unclear.AIM To investigate the biliary microbial characteristics of patients with recurrent choledocholithiasis post-EST,using next-generation sequencing.METHODS This cohort study included 43 patients,who presented with choledocholithiasis at the Guangdong Second Provincial General Hospital between May and June 2020.The patients had undergone EST or endoscopic papillary balloon dilation and were followed up for over a year.They were divided into either the stable or recurrent groups.We collected bile samples and extracted microbial DNA for analysis through next-generation sequencing.Resulting sequences were analyzed for core microbiome and statistical differences between the diagnosis groups;they were examined using the Kyoto Encyclopedia of Genes and Genomes pathway hierarchy level using analysis of variance.Correlation between the key genera and metabolic pathways in bile,were analyzed using Pearson’s correlation test.RESULTS The results revealed distinct clustering of biliary microbiota in recurrent choledocholithiasis.Higher relative abundances(RAs)of Fusobacterium and Neisseria(56.61%±14.81%vs 3.47%±1.10%,8.95%±3.42%vs 0.69%±0.32%,respectively)and the absence of Lactobacillus were observed in the bile of patients with recurrent disease,compared to that in stable patients.Construction of a microbiological co-occurrence network revealed a mutual relationship among Fusobacterium,Neisseria,and Leptotrichia,and an antagonistic relationship among Lactobacillales,Fusobacteriales,and Clostridiales.Functional prediction of biliary microbiome revealed that the loss of transcription and metabolic abilities may lead to recurrent choledocholithiasis.Furthermore,the prediction model based on the RA of Lactobacillales in the bile was effective in identifying the risk of recurrent choledocholithiasis(P=0.03).CONCLUSION We demonstrated differences in the bile microbiome of patients with recurrent choledocholithiasis compared to that in patients with stable disease,thereby adding to the current knowledge on its microbiologic etiology.展开更多
文摘The pneumonia caused by the coronavirus disease-2019(COVID-19)outbreak in Wuhan,China constitutes a public health emergency of international concern.The gastrointestinal symptoms of vomiting,diarrhea and abdominal pain and the detection of COVID-19 nucleic acid from fecal specimens in a small number of patients suggest the possibility of transmission via the gastrointestinal tract.People of all ages are vulnerable to this virus,including children.Digestive endoscopy is an invasive procedure during which children cannot wear masks;therefore,they have higher risks of exposure to COVID-19,and the digestive endoscopy center is a relatively high-risk area for COVID-19 infection.Based on these factors and in combination with related policies and regulations,a prevention and control program for the COVID-19 pneumonia in a children's digestive endoscopy center was established to prevent the COVID-19 nosocomial infection.
文摘BACKGROUND As lifestyles continue to change worldwide,the incidence of digestive tract carcinoma has gradually increased.Digestive endoscopy is an important tool that can assist in the diagnosis,treatment,and surgical intervention for this disease.However,the examination process is affected by many factors,and patient cooperation is often poor,which can increase the risk of complications.AIM To explore the effects of integrated management and cognitive intervention on cooperation and complications in patients undergoing endoscopy for early gastrointestinal neoplasms.METHODS A total of 354 patients with early stage gastrointestinal cancer who underwent digestive endoscopy procedures between January and December 2023 at our hospital were divided into observation and control groups(177 patients in each group)in a randomized controlled blind trial.The control group received routine interventions,while the observation group received comprehensive integrated management combined with cognitive interventions.We compared the changes in adverse mood,discomfort,examination time,cooperation with the examination,and complications before and after the intervention between the two groups.RESULTS The self-rated anxiety and depression scale scores were lower in the observation group than in the control group(P<0.05).The visual analog scale scores for discomfort during intubation and examination were also lower in the observation group than in the control group(P<0.05).Furthermore,the examination time was shorter in the observation group than in the control group(P<0.05),and the degree of cooperation(94.35%)was higher in the observation group than in the control group(84.75%;P<0.05).Lastly,the incidence rates of gastrointestinal adverse reactions(10.17%vs 20.34%),choking agitation(14.69%vs 24.86%),abdominal pain(8.47%vs 18.08%),and muscle tension(5.08%vs 14.12%)were all lower in the observation group than in the control group(P<0.05).CONCLUSION Integrated management and cognitive intervention in early gastrointestinal neoplasm endoscopy alleviate mood,reduce discomfort,shorten examinations,improve cooperation,and reduce complications.
文摘BACKGROUND Tens of millions of gastrointestinal endoscopic procedures are performed every year in China,but the quality varies significantly and related factors are complex.Individual endoscopist-and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy.AIM To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in China's Mainland.METHODS Selected data on endoscopy experience,equipment,facility,qualification of endoscopists,and other relevant variables were collected from the National Database of Digestive Endoscopy of China.The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance.Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications.RESULTS In 2012,gastroscopy/colonoscopy-related complications in China's Mainland included bleeding in 4,359 cases(0.02%)and perforation in 914(0.003%).Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases(0.3%),bleeding in 2,151(1.10%),perforation in 257(0.13%)and biliary infection in 4,125(2.11%).Moreover,1,313(5.0%)endoscopists encountered with medical malpractice,and 5,243(20.0%)encountered with the disturbance from patients.The length of endoscopy experience,weekly working hours,weekly night shifts,annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance.However,the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications.CONCLUSION The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance.More comprehensive data are needed to establish quality-predictive models for endoscopic complications.
基金supported by the Medical-Engineering Cross Project between University of Shanghai for Science&Technology and Naval Medical University(No.2020-RZ05)Wu Mengchao talent plan fund(to RLG)。
文摘Background:There is scant evidence regarding the effects of exercise type and duration on quality of life(QoL)in digestive system cancer(DSC)survivors.We aim to investigate the optimal type and duration of exercise to improve QoL for DSC survivors through a systematic review and network meta-analysis.Methods:A systematic literature search of PubMed,Embase,and Web of Science was performed.Eligibility for study inclusion was limited to studies that were randomized controlled trials involving all kinds of exercise in adult patients with DSCs,and the comparator was in standard care or other types of exercise.The primary outcome was QoL,including general health,physical health,mental health,and role function.Secondary outcomes included cancer-related symptoms such as fatigue,insomnia,depression,anxiety,and duration of hospital stay.The network meta-analyses were performed using a random-effect model.Results:The analysis included 32 eligible articles and a total of 2558 participants.Our primary outcome indicated that short-term aerobic exercise significantly enhanced general health(standardized mean difference(SMD)=0.66,95%credible intervals(Crls):0.05 to 1.30),and also contributed to a better mental health(SMD=0.38,95%CrI:-0.05 to 0.81)and role function(SMD=0.48,95%CrI:-0.27 to 1.20).Although without significant changes,short-term resistance exercise tended to increase the physical health of patients with DSCs(SM=0.69,95%CrI:-0.07 to 1.50)and effective in alleviating fatigue(SMD=-0.77,95%CrI:-1.50 to 0.01).Short-term aerobic exercise was related to a lower score of insomnia(SMD=-1.20,95%CrI:-2.40 to 0.06),depression(SMD=-0.51,95%CrI:-1.50 to 0.45),and anxiety(SMD=-0.45,95%CrI:-1.30 to 0.34).All types of exercise related to a trend of declined hospital stays(-0.87 to-5.00 day).Long-term resistance exercise,however,was negatively associated with general health(SMD=-0.33,95%CrI:-1.70 to 1.00),physical health(SMD=-0.18,95%CrI:-1.30to 0.90),and role function(SMD=-1.20,95%CrI:-2.50 to 0.11).Conclusion:This study suggests that short-term aerobic exercise,with or without resistance exercise programs,enhances QoL(especially for general health)as well as relieves cancer-related symptoms for DSC survivors,while long-term resistance exercise may have negative effects,and thus should be adopted cautiously.These results provide important evidence for the management of DSCs.
文摘BACKGROUND Endoscopic placement of a self-expandable metal stent(SEMS)is a minimally invasive treatment for use in malignant and benign colonic obstruction.However,their widespread use is still limited with a nationwide analysis showing only 5.4%of patients with colon obstruction undergoing stent placement.This underutilization could be due to perceived increase risk of complications with stent placement.AIM To review long-and short-term clinical success of SEMS use for colonic obstruction at our center.METHODS We retrospectively reviewed all the patients who underwent colonic SEMS placement over aeighteen year period (August 2004 through August 2022) at our academic center. Demographicsincluding age, gender, indication (malignant and benign), technical success, clinical success,complications (perforation, stent migration), mortality, and outcomes were recorded.RESULTSSixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were formalignant indications, 8 were for benign conditions. The benign strictures included diverticulardisease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemicstricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primaryor recurrent colon cancer;12 were from extrinsic compression. Fifty-four strictures occurred on theleft side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55)procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication ratewas significantly higher for benign group: Four complications were observed in the malignantgroup (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stentmigration) (P = 0.02). When stratifying complications of perforation and stent migration there wasno significant difference between the two groups (P = 0.14, NS).CONCLUSIONColon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has ahigh procedural and clinical success rate. Benign indications for SEMS placement appear to havesimilar success to malignant. While there appears to be a higher overall complication rate inbenign cases, our study is limited by sample size. When evaluating for perforation alone theredoes not appear to be any significant difference between the two groups. SEMS placement may bea practical option for indications other that malignant obstruction. Interventional endoscopistsshould be aware and discuss the risk for complications in setting of benign conditions. Indicationsin these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.
文摘Objective: to explore the clinical effect of upper digestive system hemorrhage under gastrointestinal endoscopy. Methods: the 100 patients with massive upper digestive system bleeding hospitalized from February 2018 to September 2020 were divided into two groups according to the treatment plan, 50 patients underwent gastroscopy, 50 patients received traditional hemostasis, and the results were compared with the time of hemostasis treatment. Results: comparing the efficacy of the two methods, the hemostasis visualization efficiency of 50 patients was 96% compared to 78%;the bleeding duration (0.87 + 0.35) d, admission days (3.4) d;1.89 + 1.12 d in treatment group, 5.8-2.1 d;significant differences between both groups (P 0.05);control patients (P 0.05). Conclusion: in the clinical treatment of patients with upper gastrointestinal bleeding, it can achieve an ideal hemostasis effect in a relatively short time, and has a higher safety value. It is suggested to be widely used in clinical practice.
文摘BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors.METHODS The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected.According to radical resection criteria,the patients were further divided into curative resection group(n=143)and NCR group(n=30).Clinical information was collected,including surgical method,tumor diameter,tumor site,ulcer formation,depth of invasion,pathological type,and lymph node metastasis.Logistic regression analysis was used to explore the factors affecting non-curable resection.RESULTS Multivariate logistic regression analysis showed that ulcer formation[odds ratio(OR)=3.53;95%confidence interval(CI):1.55-8.01,P=0.003],pathological type(OR=3.73;95%CI:1.60-8.74,P=0.002),tumor diameter(OR=3.15;95%CI:1.40-7.05,P=0.005),tumor location(OR=3.50;95%CI:1.16-10.58,P=0.027),lymph node metastasis(OR=4.40;95%CI:1.83-10.57,P=0.001),and depth of penetration(OR=3.75;95%CI:1.60-8.74,P=0.002)were all risk factors for NCR in EGC patients.Predictive analysis showed varying area under the curve values for factors such as tumor diameter(0.636),tumor location(0.608),ulcer formation(0.652),infiltration depth(0.658),pathological type(0.656),and lymph node metastasis(0.674).CONCLUSION The results suggest that factors such as tumor diameter,tumor location,ulcer formation,depth of invasion,pathological type,and lymph node metastasis increase the risk of NCR in EGC patients.
基金Supported by National Natural Science Foundation of China,No.82004298Jiangsu Graduate Research and Practice Innovation Program,China,No.KYCX23_2090.
文摘BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.
文摘BACKGROUND Acute abdominal pain is one of the most common gastrointestinal symptoms.The etiology of acute abdomen can be challenging for gastroenterologists to establish.Cecal foreign body is a rare cause of cecal perforation.CASE SUMMARY We report a 35-year-old male from China who initially exhibited symptoms suggestive of acute appendicitis.However,during a minimally invasive colonoscopy procedure,the authors found that a wooden toothpick caused the perforation.The patient presented to our emergency department with a 2 days history of right lower abdominal pain and low grade fever.The patient was in good health and had eaten fish 2 days earlier.Physical examination revealed mild pain with positive rebound tenderness in the right lower abdomen.However,computed tomography of the abdomen confirmed a strip of high-density shadows protruding beyond the intestinal cavity outline,with a small amount of peritoneal seepage in the ileocecal area.Combined with the medical history,the possibility of foreign body perforation by a fishbone and peripheral peritonitis were considered.However,the high-density shadow was identified as a wooden toothpick,which was removed via a minimally invasive procedure using a foreign body forceps under colonoscopy.The patient's condition improved significantly within 5 days after treatment.CONCLUSION We emphasize the importance of a detailed patient history,accurate diagnosis and proper treatment in patients with acute abdomen.
文摘BACKGROUND The clinical and pathological characteristics of primary gastric small cell carcinoma(GSCC)resemble those of small cell lung cancer,which is less sensitive to chemotherapy and has a poor prognosis.Currently,platinum-etoposide chemotherapy is a primary chemotherapy regimen for small cell carcinoma,but it is still imperfect.Programmed cell death ligand 1(PD-L1)inhibitors are recommended for the treatment of small cell lung cancer.However,to determine whether PD-L1 inhibitors are optimal for metastatic GSCC requires more clinical data.CASE SUMMARY A 67-year-old male experienced upper abdominal pain without any obvious cause for 1 week.Gastroscopy examination revealed a mass in the gastric body.Pathological examination of the biopsy specimen combined with immunohistochemistry showed a high-grade neuroendocrine carcinoma(small cell carcinoma).Genetic tests showed TP53,CREBBP,RB1,ABCB1,DNMT3A,and HGF gene mutations.Computed tomography(neck+chest+abdomen)showed multiple enlarged lymph nodes,occupying space in the greater curvature of the stomach and intrahepatic metastases.A regimen consisting of cisplatin and etoposide combined with durvalumab was administered every three weeks as palliative chemotherapy,for seven cycles.Durvalumab was then maintained every three weeks.However,the tumor recurred two months after the completion of chemotherapy.A regimen consisting of carboplatin and irinotecan combined with durvalumab was then given every three weeks.The tumor in the gastric body and liver shrank significantly,and the patient did not report any specific discomfort.CONCLUSION GSCC is a highly malignant tumor with a poor prognosis.Whether immune-related drugs are optimal for metastatic GSCC requires further exploration.
基金Supported by Heilongjiang Provincial Natural Science Foundation Team Project,No.TD2020H002.
文摘BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisum with obstruction of the minor papilla,or an abnormal patulous orifice of the minor papilla during endoscopic retrograde cholangiopancreatography(ERCP).However,the relatively low pa-tency and small opening of the minor papillae pose technical challenges.AIM To evaluate the technical success,clinical success,stone clearance,and safety pro-file of EMPI for diagnosis and treatment of symptomatic pancreatic diseases.METHODS Patients diagnosed with symptomatic pancreatic diseases and EMPI between February 1996 and February 2023 were included.The primary outcomes were the initial technical success,defined as successful deep cannulation via the minor papilla(DCMP;access of the guidewire to the upstream pancreatic duct via the minor papilla)alone,overall technical success,defined as successful DCMP alone and successful DCMP with additional needle-knife precut minor papillotomy(NKPMP),and immediate clinical success,defined as>50%improvement in abdominal pain after therapeutic EMPI.Secondary outcomes included long-term clinical success at 1,3,and 7 years,pancreatic stone clearance,and procedure-related early and late adverse events(AEs).RESULTS Overall,43 patients,32 with obstructive chronic pancreatitis,8 with pancreatic divisum,and 3 with intraductal papillary mucinous neoplasm were included.The initial and overall technical success rates were 74.4%(32/43)and 88.4%(38/43),respectively.The immediate clinical success rate was 79.1%(34/43),and the long-term clinical success rates at 1,3,and 7 years were 74.7%,55.3%,and 41.5%,respectively,among the 22 patients with a follow-up period of 57.5(7-266)months.Complete and partial success of pancreatic stone clearance was achieved in 53.9%(7/13)and 15.4%(2/13),respectively.Early AEs included post-ERCP pancreatitis(PEP,n=5)and self-limiting bleeding(n=1);surgery therapy was required for 1 case with severe PEP and conservative management for the other 4 with mild PEP.Late AEs included minor papilla stricture(n=1)after endoscopic minor papillotomy and pancreatic duct stricture(n=1)after double pancreatic stent placement;no specific treatment was implemented for these events.CONCLUSION EMPI is feasible,effective,and safe for symptomatic pancreatic diseases,in terms of the technical and clinical success,stone clearance,and incidence and severity of AEs.NKPMP appears to enhance technical success.However,potential risks of developing PEP and late AEs should be kept in mind.
基金supported by the National Natural Science Foundation of China(Grant Nos.81871959,82373143,and 82003180).
文摘Early screening is crucial for the prevention of intestinal-type gastric cancer.The current study aimed to ascertain the molecular evolution of intestinal-type gastric cancer based on the Correa cascade for precise gastric cancer screening.We collected sequential lesions of the Correa cascade in the formalin-fixed and paraffin-embedded endoscopic submucosal dissection(ESD)-resected specimens from 14 Chinese patients by microdissection,and subsequently determined the profiles of somatic aberrations during gastric carcinogenesis using whole-exome sequencing,identifying multiple variants at different Correa stages.The results showed that TP53,PCLO,and PRKDC were the most frequently mutated genes in early gastric cancer(EGC).We found a high frequency of TP53 alterations in low-grade intraepithelial neoplasia(LGIN),which further increased in high-grade intraepithelial neoplasia(HGIN)and EGC.Intestinal metaplasia(IM)showed no significant correlation with EGC in terms of mutational spectra,whereas both LGIN and HGIN showed higher genomic similarities to EGC,compared with IM.Based on Jaccard similarity coefficients,we constructed three evolutionary models,with most patients showing linear progression from LGIN to HGIN,ultimately resulting in EGC.The extracellular matrix-receptor interaction pathway was revealed to be involved in the linear evolution.Additionally,the retrospective validation study of 39 patients diagnosed with LGIN indicated that PRKDC mutations,in addition to TP53 mutations,may drive LGIN progression to HGIN or EGC.In conclusion,the current study unveils the genomic evolution across the Correa cascade of intestinal-type gastric cancer,elucidates the underlying molecular mechanisms of gastric carcinogenesis,and provides evidence for potential personalized gastric cancer surveillance.
文摘Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.
文摘AIM: To investigate the effect of prophylaxis withantibiotics on clinical adverse events in patients who underwent endoscopic submucosal dissection(ESD) or endoscopic mucosal resection(EMR) for colorectal lesions.METHODS: From June 2011 to December 2013, a total of 428 patients were enrolled into the study, of which 214 patients admitted to hospital underwent EMR or ESD procedures. These patients were randomized to an antibiotic group, in which patients were given cefuroxime 1.5 g iv half an hour before and 6 h after surgery respectively, and a control group, in which patients were not given any antibiotic. A further 214 outpatients with small polyps treated by polypectomy were compared with controls that were matched by age and gender, and operations were performed as outpatient surgery. Recorded patient parameters were demographics, characteristics of lesions and treatment modality, and the size of the wound area. The primary outcome measures were clinical adverse events, including abdominal pain, diarrhea, hemotachezia, and fever. Secondary outcome measures were white blood cell count, C-reactive protein and blood culture. Additionlly, the relationship between the size of the wound area and clinical adverse events was analyzed. RESULTS: A total of 409 patients were enrolled in this study, with 107 patients in the control group, 107 patients in the antibiotic group, and another 195 cases in the follow-up outpatient group. The patients' demographic characteristics, including age, gender, characteristics of lesions, treatment modality, and the size of the wound area were similar between the 2 groups. The rates of adverse events in the antibiotic group were significantly lower than in the control group: abdominal pain(2.8% vs 14.9%, P < 0.01), diarrhea(2.0% vs 9.3%, P < 0.05), and fever(0.9% vs 8.4%, P < 0.05) respectively. The levels of inflammatory markers also decreased significantly in the antibiotic group compared with the control group: leukocytosis(2.0% vs 11.2%, P < 0.01), and C-reactiveprotein(2.0% vs 10.7%, P < 0.05). Additionally, clinica adverse events were related to the size of the surgica wound area. When the surgical wound area was larger than 10 mm × 10 mm, there were more clinica adverse events.CONCLUSION: Clinical adverse events are not uncommon after EMR or ESD procedures. Prophylactic antibiotics can reduce the incidence of clinical adverse events. This should be further explored.
文摘BACKGROUND Endoscopic submucosal dissection(ESD) is a common surgical strategy for the treatment of early gastrointestinal tumors and precancerous lesions.PDCA nursing can effectively prevent potential risks in the nursing process,protect patient privacy,and improve patient satisfaction,nursing integrity,and service quality.AIM To explore the effects of PDCA nursing model on the quality management of gastrointestinal ESD,the 36-item Shot-Form Health Survey(SF-36) score,and negative emotions.METHODS A total of 178 patients who underwent ESD between January 2020 and January 2021 were divided into two groups.The usual care mode was the control group,with 80 cases from January to July 2020;from July 2020 to January 2021,98 patients were enrolled in the PDCA care mode as the research group.The length of hospital stay and the costs of the two groups were statistically analyzed.The visual analog scale(VAS),SF-36 score,Zung self-rating scale for anxiety and depression,and postoperative complications were also assessed.RESULTS The length of hospitalization and cost in the research group were lower than in the control group(P < 0.05),and the VAS scores were lower than those before care(P < 0.05).Moreover,the VAS score of the research group was lower than that of the control group(P < 0.05).The SF-36 scores for physical function,role status,social function,pain,mental health,and physical strength were higher in the research group than in the control group(P < 0.05).Depression and anxiety scores of the research group were lower than those of the control group(P < 0.05).The postoperative complication rate in the research group(6.12%) was lower than in the control group(32.50%)(P < 0.05).CONCLUSION PDCA nursing can improve the quality of management of ESD surgery,shorten the length of hospital stay and cost,reduce the VAS and Zung scale scores to alleviate adverse emotions,improve the SF-36 score,and reduce postoperative complications.
基金supported by the National Health Commission of China, First Affiliated Hospital of Naval Medical University(No. 2019YXK006)the Science and Technology Commission of Shanghai Municipality(No. 21Y31900100)
文摘Background:Worldwide,the volume and availability of digestive endoscopy have undergone dramatic development in recent years,with increasing attention on quality assurance.We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions.Methods:We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually.The questionnaires included the personnel,annual volume,and quality indicators of endoscopy.An endoscopy quality index(EQI)was developed based on recorded quality indicators using principal component analysis to determine the relative weight.Results:From 2015 to 2019,806,1412,2644,2468,and 2541 hospitals were respectively enrolled in this study.The average annual volume of endoscopy increased from 12,445 to 16,206(1.30-fold)and from 2938 to 4255(1.45-fold)in tertiary and secondary hospitals,respectively.The most obvious growth was observed in diagnostic colonoscopy(1.44-fold for all hospitals after standardization).The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3%(55,210/448,861)to 17.7%(85,429/482,647)and from 11.4%(69,411/608,866)to 16.9%(107,192/634,235),respectively.The adenoma detection rate of diagnostic colonoscopy increased from 14.9%(2,118,123/14,215,592)to 19.3%(3,943,203/20,431,104).The EQI model included 12 quality indicators,incorporating 64.9%(7.792/12)of the total variance into one comprehensive index.According to the EQI measurements,the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals.Conclusions:Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality.The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.
文摘BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.
基金partially supported by grants from the Jiangsu Province Social Development Program(BL2012031)the National Natural Science Foundation of China(81172266)+1 种基金the Natural Science Foundation of Jiangsu Province(BK2011859)Jiangsu Innovation of Medical Team and Leading Talents Cultivation(LJ201127)
文摘BACKGROUND： One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over- growth of bacteria. This study aimed to evaluate the feasibility of a novel silver=nanoparticle-coated polyurethane （Ag/PU） stent in bacterial cholangitis model in swine. METHODS： Ag/PU was designed by coating silver nanopar- tides on polyurethane （PU） stent. Twenty-four healthy pigs with bacterial cholangitis using Ag/PU and PU stents were ran- domly divided into an Ag/PU stent group （n=12） and a PU stem group （n=12）, respectively. The stents were inserted by standard endoscopic retrograde cholangiopancreatography. Laboratory assay was performed for white blood cell （WBC） count, alanine aminotransferase （ALT）, interleukin-1 [l （IL- 1 p）, tumor necrosis factor-a （TNF-~） at baseline time, 8 hours, 1, 2, 3, and 7 days after stent placements. The segment of bile duct containing the stent was examined histologically ex vivo. Implanted bili- ary stents were examined by a scan electron microscope. The amount of silver release was also measured in vitro. RESULTS： The number of inflammatory cells and level of ALT, IL-1β and TNF-α were significantly lower in the Ag/PU stent group than in the PU stent group. Hyperplasia of the mucosa was more severe in the PU stent group than in the Ag/PU stent group. In contrast to the biofilm of bacteria on the PU stent, fewer bacteria adhered to the Ag/PU stent. CONCLUSIONS： PU biliary stents modified with silver nanoparticles are able to alleviate the inflammation of pigs with bacterial cholangitis. Silver-nanoparticle-coated stents are resistant to bacterial adhesion.
文摘Background： Endoscopic papillary balloon dilation （EPBD） for common bile duct （CBD） stones removal in Billroth II gastrectomy patients is feasible. However, the long-term outcomes of this technique are notclear. The aim of this study was to evaluate the procedural and long-term outcomes of EPBD for removal of CBD stones in Billroth II gastrectomy patients.
基金Supported by the research grants from Guangdong Provincial Key Laboratory,No.2020B121201009the Science Foundation of Guangdong Second Provincial General Hospital,No.YQ2019-014GDAS’Project of Science and Technology Development,No.2020GDASYL-20200301002。
文摘BACKGROUND Choledocholithiasis is a severe disorder that affects a significant portion of the world’s population.Treatment using endoscopic sphincterotomy(EST)has become widespread;however,recurrence post-EST is relatively common.The bile microbiome has a profound influence on the recurrence of choledocholithiasis in patients after EST;however,the key pathogens and their functions in the biliary tract remain unclear.AIM To investigate the biliary microbial characteristics of patients with recurrent choledocholithiasis post-EST,using next-generation sequencing.METHODS This cohort study included 43 patients,who presented with choledocholithiasis at the Guangdong Second Provincial General Hospital between May and June 2020.The patients had undergone EST or endoscopic papillary balloon dilation and were followed up for over a year.They were divided into either the stable or recurrent groups.We collected bile samples and extracted microbial DNA for analysis through next-generation sequencing.Resulting sequences were analyzed for core microbiome and statistical differences between the diagnosis groups;they were examined using the Kyoto Encyclopedia of Genes and Genomes pathway hierarchy level using analysis of variance.Correlation between the key genera and metabolic pathways in bile,were analyzed using Pearson’s correlation test.RESULTS The results revealed distinct clustering of biliary microbiota in recurrent choledocholithiasis.Higher relative abundances(RAs)of Fusobacterium and Neisseria(56.61%±14.81%vs 3.47%±1.10%,8.95%±3.42%vs 0.69%±0.32%,respectively)and the absence of Lactobacillus were observed in the bile of patients with recurrent disease,compared to that in stable patients.Construction of a microbiological co-occurrence network revealed a mutual relationship among Fusobacterium,Neisseria,and Leptotrichia,and an antagonistic relationship among Lactobacillales,Fusobacteriales,and Clostridiales.Functional prediction of biliary microbiome revealed that the loss of transcription and metabolic abilities may lead to recurrent choledocholithiasis.Furthermore,the prediction model based on the RA of Lactobacillales in the bile was effective in identifying the risk of recurrent choledocholithiasis(P=0.03).CONCLUSION We demonstrated differences in the bile microbiome of patients with recurrent choledocholithiasis compared to that in patients with stable disease,thereby adding to the current knowledge on its microbiologic etiology.
